Category Archives: toilet training

The Difference Between Special Needs and Typical Potty Training Approaches: Address Sensory/Behavioral Issues and Use Consistent Routines

tai-jyun-chang-270109.jpgAfter writing The Practical Guide to Toilet Training Your Child With Low Muscle Tone, I have been asked what was different about my book. There must be 100 books on potty training special needs kids. What did I do differently? Simple. I am an occupational therapist, so I have no choice but to use my 360 degree viewpoint to target all the skills needed to do the job. Seeing the path to independence in this way was second nature to me, but not to parents of kids with special needs. Time to offer some support!

The books I reviewed before I started writing were great, but every one lacked at least one important feature. If the authors were psychologists and teachers, they weren’t fully comprehending or directly addressing the sensory and motor aspects of a very physical skill. Oops.

OTs are always aware of the cognitive and social/behavioral components of activities of daily living, but we also have a solid background in physiology and neurology as well. That makes us your go-to folks for skills like toilet training. And that is a major reason why The Practical Guide is so helpful to the frustrated parents of children with SPD,autism, Down Syndrome, Ehlers-Danlos Syndrome, and a host of other diagnoses that result in delays or difficulties with muscle tone and potty training independence. It explains in detail how low tone creates sensory, motor, and social/behavioral problems, and how to address them. Knowledge is power, and knowledge leads to independence.

The other huge difference is that developing consistent sensory-motor-behavioral routines matter more for these kids. Tone isn’t a constant, as anyone with a child that has low tone knows all too well. Fatigue, illness, even a very warm day; these all make kids less stable and can even reduce their safety. Having a really solid routine makes movements easier to execute and more controlled when situations aren’t perfect. Kids with normal muscle tone can shift their behavior on the fly. They can quickly adjust and adapt movement in ways that children with low tone simply cannot. It isn’t a matter of being stubborn or lazy. Kids with low tone aren’t going to get the sensory feedback fast enough to adjust their motor output.

Good motor planning on a “bad day” occurs for these kids when they have well-practiced routines that support safe and smoothly executed movements. What makes the difference isn’t intelligence or attention. It is recalling a super-safe routine effortlessly. This is completely attainable for kids who have speech or cognitive issues as well as issue with low tone and instability. It may take them longer to learn the routine, but it pays them back with fewer accidents and fewer tears.

To learn more about my book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, visit my website, tranquil babies.com, or view it on Amazon.com!ferris-wheeltai-jyun-chang-270109

Teach Kids With EDS and Low Tone: Don’t Hold It In!

People who have read my blog are aware that I wrote a book on toilet training, The Practical Guide to Toilet Training Your Child With low Muscle Tone. This toileting habit didn’t make it into the book, but perhaps it should have. Children that have issues with muscle tone or connective tissue integrity, or both, risk current and future issues with incontinence if they overstretch these structures too far. We teach little girls to wipe front-to-back to prevent UTIs. We need to teach all children with these issues to avoid “holding it in” in the same manner that we discourage them from w-sitting.

I am specifically speaking about kids with Ehlers Danlos Syndrome, Down Syndrome and all the other conditions that create pelvic weakness and control issues. But even if your child has idiopathic low tone, meaning that there is no identified cause, this can still be a current or future problem.

The effects of low tone and poor tissue integrity on toilet training are legion. Many of them are sensory-based, a situation that gets very little acknowledgment from pediatricians. These children simply don’t feel the pressure of their full bladder or even a full rectum with the same intensity or discomfort that other children experience. This is known as poor interception, a sensory-based issue that is rarely discussed, even by Its that are all over other sensory processing issues.  These kids are “camels” sometimes, with no urge to pee, and have to be reminded to void. It can be convenient for the busy child to keep playing rather than go to the bathroom, or it can save embarrassment for the shy child who prefers to wait until she returns home to “go”.

This is not a good idea. The bladder is a muscle that can be overstretched in the same manner as the hip muscles that are the concern of children who “W-sit”. Don’t overstretch muscles and then expect them to work well. The ligaments that support the bladder are subject to the same sensory-based issues that affect other ligaments in the body: once stretched, they don’t bounce back. A weak pelvic floor is nothing to ignore, and age doesn’t help anyone. Ask older women who have had a few pregnancies how that is going for them. The stretch receptors in the abdomen that should be telling a child with low tone that it is time to tinkle just don’t get enough stretch stimulation to do so when they have been extended too far. The time to prevent problems is when a child is developing toileting habits, not when problems have developed.

So….an essential part of toileting education for children is when to head to the bathroom. If your child has low muscle tone or a connective tissue disorder that creates less sensory-based information for them, the easiest solution is a routine or a schedule. They use the bathroom whether they feel they need to or not. The older ones can notice how much they are voiding, and that tells them that they really did need to “go”. Understanding that the kidneys will fill up a bladder after a large drink in about 35-45 minutes is helpful. But it can be a trip after a meal, before leaving the house, or when returning home. As long as it is routine and relatively frequent, it may not matter how a toileting schedule is created. Just make sure that as they grow up, they are told why this is important. A continent child may not believe that this could prevent accidents, but a child who has a history of accidents may be your best student.

For little girls who are at a higher risk of UTIs, I tell parents to teach wiping after urination as a “pat-pat” rather than the standard recommendation of front-to-back wiping.  Why?  Because children aren’t really good at remember that, and even if you are standing right their reminding her, she may just wipe back-to-front because that is easier and more natural.  “Pat-pat” is equally easy and reduces her risk of fecal contamination.  Cannot tell you I have done hard research on this, but then, I have common sense.  It is the smarter move.

The good news in all of this? Perceiving sensory feedback can be improved. There are higher-tech solutions like biofeedback, but children can also become more aware without tech. There are physical therapists that work on pelvic and core control, but some children will do well with junior Kegel practice and some education and building awareness of the internal sensations of fullness and urgency.

Good luck, and please share your best strategies here for other parents!!

If you are interested in purchasing my book, please visit my website, tranquil babies.com, and click on “e-book” at the top ribbon. You can also buy it on Amazon.com. My e-book is designed to help parents, not just offer statements like “Don’t push your child” and “Look for signs of readiness”. That doesn’t help anyone! The book has useful readiness checklists and detailed strategies for every stage of training!

“Toilet Training Season” Is Coming. Do You Have a Plan?

 

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Here in the northeast, the buds on the trees are reminding parents that it will be time to sign up for summer camps and preschool.  And therefore toilet training season is upon us.  Most schools for typically-developing kids over 3 don’t accept children that aren’t trained.  If they do, they may demand a surcharge, have only a few classrooms for older kids in diapers, or limit activities such as the use of swimming pools.

If you are thinking that now is the time to train, you are probably wondering if you are going to use the “Boot Camp” approach, or the “Gradual Training” approach.  Going all in is the “Boot Camp” method.  Your child’s life, and yours, is focused on learning the mechanics of using the toilet and perceiving when to run to the potty.  “Gradual Training” is slowly developing awareness and skills in young children.  You might start from a very early age, describing your actions during a diaper change and demonstrating what potties are for, and that it is both something grown-ups do and not anything to be afraid of.

Either way can be totally successful, and your choice rests on their temperament and yours, your timeline, and your available support.  If your child doesn’t handle failure well, or would find it difficult to spend a whole weekend in or near the potty, then you might consider Gradual Training.  If your child learns best by frequent repetition and rewards, then Boot Camp has appeal.  If you have no one else to watch other kids or you know your patience will be strained by a day of (your child) drinking and peeing, then you may want to go Gradual.   I want to emphasize that choosing the approach you take by looking at your own abilities and limitations is important.  So often, parents discount their feelings and end up displaying their frustration or boredom to their child.  Here is the bad news:  children think that negative parental moods are THEIR FAULT!  Choose wisely, and both of you feel good about yourselves and the experience.  Choose poorly, and you both get more aggravation than you expected.

So now that the season for training is upon us, choose your plan and get ready to give your child all the support and encouragement that you can!

Want more help?  My new e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is available on my website, tranquil babies .  Just look for the ribbon at the top and click on “e-book”.  I go into all the details on whether your child is really ready for training, provide you with checklists for readiness, and give you an in-depth explanation of the Boot Camp and Gradual Training methods.  Halfway there and experiencing some resistance?  The chapter “Bumps In The Road” is for you!  

To get a sense of how I view true readiness, check out my post Low Tone and Toilet Training: The 4 Types of Training Readiness.  While not as complete as the chapter in the book, this will start you thinking about readiness in a different way.

Low Tone and Toilet Training: Learning to Hold It In Long Enough to Make It to The Potty

 

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If your child can’t stay dry at night after 5, or can’t make it to the potty on time, there are a number of things that could be going wrong.  I won’t list them all, but your pediatrician may send you to a pediatric urologist to evaluate whether there are any functional (kidney issues, thyroid issues, adrenal issues etc.) or structural issues ( nerve, tissue malformations).  If testing results are negative, some parents actually feel worse rather than better.

Why?  Because they may be facing a situation that is harder to evaluate and treat:  low tone reducing sensory awareness and pelvic floor control.

Yes, the same problem that causes a child to fall off their chair without notice can give them potty problems.  When their bladder ( which is another muscle, after all) isn’t well toned, it isn’t sending sensory information back to the brain.  The sensors that respond to stretch aren’t firing and thus do not give a child accurate and timely feedback.  It may not let them know it is stretched until it is ready to overflow.  If the pelvic floor muscles are also lax, similar problems.  Older women who have been pregnant know all about what happens when you have a weak pelvic floor.  They feel like they have to “go”  but can’t hold it long enough to get to the bathroom!   Your mom and your daughter could be having the same problems!!

What can you do to help your child?  Some people simply have their kids pee every few hours, and this could work with some kids in some situations.  Not every kid is willing to wear a potty watch (they do make them) and the younger ones may not even be willing to go.  The older ones may be so self-conscious that they restrict fluids all day, but that is not a great idea.  Dehydration can create medical issues that they can’t fathom.  Things like fainting and kidney stones.

Believe it or not, many pediatric urologists don’t want kids to empty their bladder before bedtime.  They want kids to gradually expand the bladder’s ability to hold urine for a full 8-10 hours.  I think this is easier to do during the day, with a fully awake kid and a potty close at hand.  Too many accidents make children and adults discouraged.  Feeling like a failure isn’t good for anyone, and children with low tone already have had frustrating and embarrassing experiences.  They don’t need more of them.

There are a few ideas that can work, but they do take effort and skill on the part of parents:

First, practice letting that bladder fill up just enough for some awareness to arise.  You need to know how much a child is drinking to figure out what the right amount is, and your child has to be able to communicate what they feel.  This is going to be more successful with children with at least a 5-6 year-old cognitive/speech level.  Once they notice what they are feeling down there right before they pee, you impress on them that when they feel this way that they can avoid an accident by voiding as soon as they can.  Try to get them to create their own words to describe the sensation they are noticing.  That fullness/pressure/distention may feel ticklish, it may be felt more in their belly than lower down; all that matters is that you have helped your child identify it and name it.

You have to start with an empty bladder, and measure out what they are drinking so you know approximately how much fluid it takes them to perceive some bladder stretching.    It helps if you can measure it in a way that has meaning for them.  For me, it would be how many mugs of coffee.  For a child it might be how many mini water bottles or small sport bottles until they feel the need to “go”.  You also need to know how long it takes their kidneys to produce that amount of urine.  A potty watch that is set to go off before they feel any sensation isn’t teaching them anything.

The second strategy I like involves building the pelvic floor with Kegels and other moves.  Yup, the same moves that you do to recover after you deliver a baby.  The pelvic floor muscles are mostly the muscles that you contract to stop your urine stream.  Some kids aren’t mentally ready to concentrate on a  stop/start exercise, and some are so shy that they can’t do it with you watching.  But it is the easiest way to build that pelvic floor.  There are other core muscle exercises that can help, like transverse abdominal exercises and pelvic tilt exercises.  Boring for us, and more boring for kids.  But they really do work to build lower abdominal strength.  If you have to create a reward system for them to practice, do it.  If you have to exercise  with them, all the better.  A strong core and a strong pelvic floor is good for all of us!

Finally, don’t forget that the same things that make adult bladders edgy will affect kids.  Caffeine in sodas, for example.  Spicy foods.  Some medications for other issues irritate bladders or increase urine production.  Don’t forget constipation.  A full colon can press on a full bladder and create accidents.

Interested in learning more about toilet training?  My e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone is available on my website, tranquil babies.  Just click ‘e-book” on the ribbon at the top of the home page, and learn about my readiness checklists, and how to deal with everything from pre-training all the way up to using the potty in public!

 

 

 

 

Why is Staying Dry at Night So Challenging For Some Children?

I have received a few questions on this subject since publishing my e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone.  Parents are wondering how to expand daytime success through the night.  Here is what I know about getting through the night high and dry:  it is as much a physical milestone as a behavioral accomplishment.  The pituitary gland is involved in hormonal secretions to diminish urine production, and the nerves for sphincter control may not be fully developed in younger children.  The bladder has to expand to hold a quantity of urine at night, so tiny children really cannot accomplish this feat, regardless of motivation.

Typical children who are dry all day can need another 2-4 years (yes, years!) to stay dry at night and/or wake themselves and use the potty independently.  The child who is a “potty master”, getting there on time and managing all the skills at school, may still need a pull-up style training pant as an insurance policy.

What can you do to improve the odds of dryness at night?

  • Limit drinks right before bed.  As you know from my book, children will generate enough urine to “go” about 45 minutes after a big drink.  The kidneys are also responding to hormone and salt levels in the blood, so some urine will be generated at night, even if nothing has been taken in by mouth for 2 hours before bed.  Deny that late night sippy cup or that last swig of juice, and come up with a better bedtime routine in it’s place.
  • Insist on the bathroom being a last stop before bedtime.  Empty that bladder, even if your child insists that they don’t feel that they need to “go”.
  • Make sure your child is well hydrated during the day.  A thirsty child is going to beg for that drink, and then fail to stay dry.  The bladder gets it’s exercise during the day, as it fills and empties.  Constantly running to the bathroom, or never making it to the bathroom can both contribute to late preschool bedwetting.  Be encouraging but firm with children that tend to dry out during the day.  They don’t realize the part their refusal plays in bedwetting, they just feel like a failure, and maybe worry that they are a failure in your eyes as well.
  • Recognize the role of constipation can play in bedwetting.  The pressure of stool on a bladder can be enough to create problems.  My book has many ideas to address constipation, and this is another reason to address this problem instead of hoping it will go away.
  • Accept that brain maturation is a key driver of night dryness.  A child with brain differences, from ASD to ADHD to SPD, may need more time to achieve this milestone.  Criticism and harshness isn’t going to make that brain develop any faster.
  • Ask your pediatrician’s advice if your typical child isn’t dry at night by 7, or if you suspect that there is another issue.  Never ignore your gut feelings about your child.  You know more than you think!

Take a look at The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived! to learn more about my e-book and how it can help you toilet train your child!  Visit my website tranquil babies to purchase the book and buy a phone consultation to get your specific questions answered personally!

Toilet Training Older Kids: Equipment Matters as Much as Approach

Is potty training after the toddler years different?  Yes, and no.  Here is what you need to consider when you are looking at the equipment for an older child that is still in a diaper or a pull-up.  Whether they have language or not, whether they have rigid or stereotyped behaviors or not, your set-up when training the older child is very important.

  1. Your child probably won’t fit correctly on a toddler potty seat.  Unless your child is significantly shorter and thinner than her peers, she won’t fit.  Children that are nonverbal or very compliant may not complain about sitting so low or so tightly.  They just won’t do well.  They may only sit for a short time, get agitated, or withhold.   They may cling to you when transferring on and off because they are sitting so low.  It can look like they either don’t understand what to do, or won’t comply.  Both can be wrong.  The defiant ones will cry and refuse to use a seat that doesn’t fit them.  Some crafty parents have adapted the smaller seats for their slim little ones, but not everybody can do that.  Look at my post on the adult toilet Low Tone and Toilet Training: Transition to Using The Adult Toilet for help to reconfigure your set-up ,giving your child a better chance at success and comfort.
  2. The right environment for toileting is not in front of the TV.  After all these years of using diapers or pull-ups (which is developmentally really a diaper that you wear, not absorbent underwear), using the toilet can seem as silly to them as going into a restaurant and cooking our own dinner would be to us!  If you have the room, use the bathroom for training.  Bring them into the fold by requiring them to assist you with all aspects of diapering, turn off the TV so you have their attention, and when you do watch potty videos, make sure you are there reminding/encouraging them.  Your demonstrated interest has more power than you think!
  3. You are gonna need a bigger boat (wipe).  Nod to one of my favorite movies, Jaws.  But seriously, using those tiny little toddler wipes from the cute dispenser might not do the job on a 5 year-old heine.  Not enough wiping with a tiny one, and if they aren’t clean down there, it is not only messy, it is a hygeine issue.  Use the grown-up wipes and put Paw Patrol stickers on it if you have to sell them as appealing.

Good news!  My e-book, The Practical Guide to Toilet Training Your child With Low Muscle Tone, is up on my website, tranquil babies .  For a sense of what it includes, take a look at The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived!  I took all the requests from my consultation clients, and my years of experience as a pediatric OTR, and wrapped it into a book that gives you real help, not just charts or encouragement that it takes time.  If you want a hard copy, go to my website and send me an e-mail to find out how to get one!

Piddlers Make Potty Training Fun!

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Your son will eagerly run for potty time!

I laughed out loud the first time I saw a toddler pee onto one of these circles.  Then he asked for more juice so that he could come back later and try again!

Piddlers aren’t a new concept.  Parents have been tossing cereal circles into a potty for “aiming practice” for a long time.  These commercially-made circles are just easier to aim for, dissolve more, and clean up easily.  Cereal has a funny way of bouncing around in the toilet, making it more frustrating, not as successful and not as much fun.

Getting children motivated to use the toilet can be a big headache.  For every totally cooperative toddler, there are 5 more that are defiant or simply uninterested.  They just won’t “go”.  Piddlers may not be a total answer, but they can get your son over these barriers to skill development.  Once a child is successful and has a routine, things are so much better!

Little boys have to control their aim if they are going to urinate standing up.  This is a totally new concept for them, and a skill.  Yes, a skill.  Since they have been using a diaper for elimination from the day they came home from the hospital, toilet training is a completely foreign concept, from beginning to end.  It’s a little bit funny: mostly the mommies are in control of toilet training, but only brothers, cousins and daddies can demo this particular skill.   Read Low Tone and Toilet Training: Kids Need To See How It’s Done to understand why a live performance can jump-start your child’s comprehension of toilet use.

Piddlers are made of starch and food coloring, and won’t turn anything blue or orange.  You may not even need the whole package!  Once a child has success and has developed a routine, explain that you need to go to the store later to buy more (not really), but he can use the potty right now anyway without one or two Piddlers in the potty.  Eventually you won’t need Piddlers any more, but you will have a little boy that is paying attention to what he is doing in the bathroom!

Great News!  My book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, is now available as an e-book on my website, tranquil babies .  Just click the “e-book” section on the top ribbon to get your copy.  

Don’t think your child is ready for toilet training?  You need this book more than the parents of kids that are struggling with training!  Knowing how to prepare your child and yourself before you start training can make all the difference.  My book will explain in detail what you need to know and how you can start developing potty skills…today!